Abstract
This new position statement from the American Occupational Therapy Association (AOTA) describes occupational therapy's role in pain management. AOTA asserts that occupational therapy practitioners are distinctly prepared to work independently and to contribute to interprofessional teams in the treatment of pain. Practitioners strive to ensure active engagement in meaningful occupations for clients at risk for and affected by pain.
AOTA's new position statement describes occupational therapy’s role in pain management.
The American Occupational Therapy Association (AOTA) asserts that occupational therapists and occupational therapy assistants, collectively referred to as occupational therapy practitioners (AOTA, 2020b), are distinctly prepared to work independently and to contribute to interprofessional teams in the treatment of pain. Occupational therapy practitioners work to ensure active engagement in meaningful occupations for “persons, groups, or populations (i.e., the client)” (AOTA, 2020b, p. 1) at risk for and affected by pain.
The U.S. Department of Health and Human Services (HHS; 2019) has recognized pain as a public health problem that has significant physical, emotional, and societal costs, estimated at $560 billion to $635 billion annually in the United States. An estimated 50 million U.S. adults and 5% to 38% of children and adolescents are affected by chronic pain (Dahlhamer et al., 2018; HHS, 2019). According to the Institute of Medicine (IOM; 2011), “pain is one of the most common reasons people seek treatment” (p. 155). Pain has been found to affect a person’s ability to exercise, enjoy normal sleep, perform household chores, attend social activities, drive a car, walk, have sexual relations, maintain relationships, and find enjoyment in life (Dorfman, 2018; World Health Organization [WHO], 2004). Efforts to improve care for people affected by pain have been influenced and, at times, complicated by initiatives to combat the opioid crisis (HHS, 2019). HHS has described the opioid crisis as lying at the intersection of two public health challenges: reducing the burden of suffering from pain and containing the harms resulting from prescription opioid medications. Unfortunately, initiatives to address the potential harms of opioid medications have had unintended consequences for some people with chronic pain, such as limited access to treatment for pain, stigma, and rising suicide rates (HHS, 2019).
Overview: Understanding Pain
In 2020, the International Association for the Study of Pain (IASP) provided a revised definition of pain: “an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage” (Raja et al., 2020, p. 1976). Pain is a subjective experience unique to the person, one that is influenced by biological, psychological, and social factors. The purpose of pain is to protect the person from actual, potential, or perceived harm. Nociceptive pain results from actual or threatened damage to non-neural tissue and is caused by activation of nociceptors. Nociceptors are sensory receptors in the peripheral somatosensory nervous system that are able to transduce and encode noxious stimuli (IASP, 2017). When noxious stimuli are encoded, nociception occurs (IASP, 2017). Neuropathic pain is caused by lesions or diseases occurring in the central or peripheral nervous system (IASP, 2017). Nociplastic pain can occur as a result of altered nociception, without evidence of threatened or actual tissue damage or disruption to the somatosensory nervous system. Inadequately treated pain can result in adverse effects such as “delays in healing, changes in the central nervous system (neuroplasticity), suicidal ideation and behavior,” and aberrant opioid medication behaviors (Cheatle, 2016, p. 44).
Acute pain typically occurs suddenly; is usually associated with a specific event, injury, or illness; and is expected to last a short duration (IOM, 2011). Acute pain that is not effectively managed may increase recovery time and contribute to hospital readmissions (Baratta et al., 2014). Chronic pain has been defined as “pain that persists or recurs for more than 3 months” and requires special treatment and care (Treede et al., 2019, p. 19). Categories of chronic pain proposed by the IASP for the International Classification of Diseases (11th rev.; WHO, 2021) include chronic primary pain syndromes and chronic secondary pain syndromes (Treede et al., 2019; see examples in Table 1). In chronic primary pain, pain can be a disease in itself; in chronic secondary pain, pain is a symptom of an underlying condition.
Classification and Examples of Chronic Pain Syndromes in the International Classification of Diseases, 11th Revision
Source. World Health Organization (2021).
Social and economic determinants of health have been found to correlate with chronic conditions, including pain (Goldberg & McGee, 2011). HHS (2019) noted that “various populations have unique issues that affect acute and chronic pain,” including “children, older adults, women, pregnant women, individuals with SCD [sickle cell disease], individuals with other chronic relapsing pain conditions, racial and ethnic minority populations, active duty service members and veterans, and patients with cancer and those in palliative care” (p. 44).
The evidence supports occupational therapy’s belief that occupational engagement promotes health and well-being (Stav et al., 2012). Participation in the meaningful occupations of activities of daily living (ADLs), instrumental activities of daily living (IADLs), health management, rest and sleep, education, work, play, leisure, and social participation can be significantly limited for people with pain. It is estimated that of the 50 million U.S. adults with chronic pain, 19.6 million experience high-impact pain, which is pain that interferes with daily life or work activities (Dahlhamer et al., 2018).
People with chronic pain report significant changes in psychological state, occupational performance, relationships, and life satisfaction (Fisher et al., 2007). The long-term consequences of chronic pain include risk for developing additional physical dysfunctions, psychological disorders such as depression, impaired memory and attention, impaired sleep, impaired sexual function, impaired quality of life, increased economic burden, and interference with work performance (Fine, 2011). Stigma, especially for those receiving opioid therapy, can originate at the patient, provider, and societal levels and can create a significant barrier to treatment of people with chronic pain (HHS, 2019). Stigma of people with chronic pain not associated with opioid treatment has also been identified. People with chronic pain report that they often do not feel believed by romantic partners, family, friends, and their health care providers (Cosio & Demyan, 2021).
Model for Care
Before the 1960s, pain was treated predominantly under the biomedical model, which viewed pain as a primarily medical issue requiring a physical treatment (Jensen & Turk, 2014). As Jensen and Turk (2014) noted, studies have demonstrated that chronic pain may worsen when treated according to the biomedical model (e.g., Chan & Peng, 2011; Deyo & Mirza, 2009). Since the recognition that pain is influenced by more than biological factors and can present as a chronic condition, the biopsychosocial model of pain has become the most widely used approach to the treatment of pain and is thought to be more effective than biomedical approaches.
The biopsychosocial model of pain “evaluates the integrated ‘whole person,’ with both the mind and the body together as interconnected entities, recognizing biological, psychological, and social components of pain and illness” (Bevers et al., 2016, p. 99). The biopsychosocial model of pain emphasizes that with chronic pain, as with other chronic illnesses, the emphasis in treatment is on not a cure but the reduction and management of symptoms and their impact on health and well-being (Gachtel & Howard, 2018). The approach to reducing pain’s impact on health and well-being includes self-management, which relates to the activities a person carries out to increase skills and confidence in managing their health problems (IOM, 2003). The Pain Management Best Practices Inter-Agency Task Force recognized the importance of “patient self-management support as part of patient-centered care and as a mechanism for improving pain outcomes” (HHS, 2019, p. 61).
Occupational Therapy’s Role in Pain Management
Occupational therapy practitioners work to increase clients’ engagement in meaningful and enjoyable occupations, which has been shown to result in reported reductions in pain (Fisher et al., 2007). The Occupational Therapy Practice Framework: Domain and Process (4th ed.; OTPF–4; AOTA, 2020b) provides guidance for practitioners on the process of delivering occupational therapy services. Occupational therapy practitioners apply their expertise in the evaluation process by creating the occupational profile to determine the client’s “occupational history and experiences, patterns of daily living, interests, values, needs, and relevant contexts” (AOTA, 2020b, p. 21) and then synthesize that information to determine how each affects the client’s pain experience and occupational engagement.
Occupational therapy’s role in pain management is supported by the clear compatibility of occupational therapy’s foundational principles, philosophies, models, frameworks, interventions, and training with recommendations for the treatment of pain. Consistent with the biopsychosocial model, “occupational therapy practitioners recognize the importance and impact of the mind–body–spirit connection on engagement and participation in daily life” (AOTA, 2020b, pp. 6–7). The OTPF–4 states that occupational therapy’s focus on “the whole is considered stronger than a focus on the isolated aspects of human functioning” (AOTA, 2020b, p. 7) and “that active engagement in occupation promotes, facilitates, supports, and maintains health and participation” (p. 5), reflecting WHO’s (2006) view that “health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (p. 1). This understanding distinctly prepares occupational therapy practitioners to work within the biopsychosocial model to assess and address “physical, cognitive, psychosocial, sensory–perceptual, and other aspects of performance in a variety of contexts and environments to support engagement in occupations” that may be affected by pain (AOTA, in press, p. 1).
HHS (2019) has recognized occupational therapy as a provider of restorative therapies that “play a significant role in acute and chronic pain management” (p. 31). Occupational therapy practitioners have further been recognized as “the ideal therapeutic leaders” for functional restoration, an approach carried out by an interdisciplinary team that addresses functional outcomes as a primary focus instead of reduction of pain (Harden et al., 2013, p. 12). HHS (2019) has recommended that people with pain receive a comprehensive assessment paired with a multidisciplinary treatment plan targeting “measurable outcomes that focus on improvements, including quality of life . . . , improved functionality, and activities of daily living” (p. 1). HHS recommendations for people with pain also focus on improving self-management, which occupational therapy practitioners recognize as a component of managing health. Within occupational therapy practice, health management is more than just knowledge acquisition; it also includes “activities related to developing, managing, and maintaining health and wellness routines, including self-management, with the goal of improving or maintaining health to support participation in other occupations” (AOTA, 2020b, p. 32). Occupational therapy’s distinct value in addressing self-management and guiding clients to integrate new skills and routines within the context of their lived experience is not found in other health care professions.
Guidance for Occupational Therapy Practitioners
Because of the prevalence of acute and chronic pain, occupational therapy practitioners encounter individuals, groups, and populations affected by or at risk for pain across all practice settings. Practitioners are prepared to address the impact of acute and chronic primary and secondary pain on occupational engagement. The unique skill set of occupational therapy practitioners and application of the OTPF–4 facilitate successful evaluation and treatment of pain in individuals, groups, and populations (see Exhibits 1–6 for specific case examples).
Anna, Age 12: Juvenile Idiopathic Arthritis and Fibromyalgia
Note. ADLs = activities of daily living; CHAQ = Childhood Health Assessment Questionnaire; COPM = Canadian Occupational Performance Measure; FDI = Functional Disability Inventory; JIA = juvenile idiopathic arthritis; OT = occupational therapy/occupational therapist; PT = physical therapy/physical therapist; ROM = range of motion.
Gary, Age 69: L2–S1 Fusion Revision With L4–L5 Laminectomy and Discectomy
Note. ADLs = activities of daily living; AFO = ankle-foot orthosis; AOTA = American Occupational Therapy Association; CMS = Centers for Medicare & Medicaid Services; COPM = Canadian Occupational Performance Measure; IADLs = instrumental activities of daily living; IRF–PAI = Inpatient Rehabilitation Facility Patient Assessment Instrument; IV = intravenous; NA = Narcotics Anonymous; OT = occupational therapy; PTSD = posttraumatic stress disorder; SMART = Specific, Measurable, Achievable, Relevant, and Time-bound; TENS = transcutaneous electrical nerve stimulation; TLSO = thoracic lumbar sacral orthosis; VAS = visual analog scale.
Carrie, Age 27: Polytrauma Sustained in a Motor Vehicle Accident
Note. ADL = activity of daily living; AOTA = American Occupational Therapy Association; AROM = active range of motion; CMS = Centers for Medicare & Medicaid Services; COPM = Canadian Occupational Performance Measure; IRF = inpatient rehabilitation facility; IRF–PAI = Inpatient Rehabilitation Facility Patient Assessment Instrument; LB = lower body; LE = lower extremity; NRS = Numeric Rating Scale; OT = occupational therapy/occupational therapist; OTA = occupational therapy assistant; PT = physical therapy/physical therapist; UB = upper body; UE = upper extremity.
Tom, Age 43: End-Stage Lung Cancer and AIDS
Note. FLACC = Face, Legs, Activity, Cry, Consolability; NRS = Numeric Pain Rating Scale; OT = occupational therapy/occupational therapist.
Robin, Age 35: Complex Regional Pain Syndrome Type 2
Note. ADLs = activities of daily living; AROM = active range of motion; CRPS = complex regional pain syndrome; IADLs = instrumental activities of daily living; OEP = Occupational Experience Profile; OT = occupational therapy/occupational therapist; PT = physical therapy.
Group Intervention: Adults Scheduled for Elective Total Hip or Total Knee Arthroplasty
Note. AOTA = American Occupational Therapy Association; IADLs = instrumental activities of daily living; OT = occupational therapy; PT = physical therapy.
Evaluation and Assessment
The occupational therapy process begins with evaluation, which includes the development of the occupational profile and the analysis of occupational performance, taking into account the impact of pain (AOTA, 2020b). In addition to physical, cognitive, psychosocial, and sensory–perceptual factors related to occupational engagement, the practitioner identifies the presence, intensity, location, type, and frequency of pain and assesses the client’s pain coping skills (HHS, 2019), pain perceptions (HHS, 2019), cognitive and emotional responses to pain (HHS, 2019), and pain self-efficacy (Simon & Collins, 2017).
The administration of specific pain assessments (see Table 2 for examples) provides data to document the client’s subjective experience of pain. The practitioner synthesizes this information and develops an intervention plan to address the client’s engagement in meaningful occupations.
Examples of Pain Assessments
The occupational therapy process is guided not only by the biopsychosocial model of pain but also by occupational therapy–based models and frames of reference. Commonly used occupational therapy models and frames of reference that align with the biopsychosocial model of pain include the Person–Environment–Occupational Performance (PEOP) Model and the Model of Human Occupation (MOHO). In the PEOP Model, biological and psychological factors are considered intrinsic (person) factors, and social factors are considered extrinsic (environment) factors (Christiansen et al., 2005). The MOHO also recognizes the dynamic interaction between person characteristics, including volition, habituation, and performance skills, and the environment (Park et al., 2019). Many other occupational therapy models and frames of reference are consistent with the biopsychosocial model, including the Canadian Model of Occupational Performance and Engagement, Occupational Adaptation Model, Theory of Occupational Adaptation, and cognitive–behavioral frame of reference.
Interventions
The OTPF–4 directs occupational therapy practitioners through the intervention process and targeting of outcomes. The occupational therapy process focuses on using occupations therapeutically to achieve an outcome of greater participation. For individual clients with pain, this process may focus on implementing nonpharmacological interventions for improving pain self-management that allow the client to increase participation in occupation. For a group client, the practitioner may provide education to the multidisciplinary team regarding the biopsychosocial model of pain. Population-based interventions may include providing back injury prevention training or ergonomics training in employment settings.
Clients with chronic pain who have had frequent encounters with the health care system may be frustrated by the persistence of their pain despite receiving services and by their experiences with stigma (Dow et al., 2012). Occupational therapy practitioners should be intentional in building the therapeutic alliance through a focus on client-centered care and respect for the client’s lived experience of pain, a process often referred to as therapeutic use of self. Studies have indicated that a strong therapeutic alliance can improve the outcomes of people with pain (Kinney et al., 2018; Lewis et al., 2010).
Because self-management is an important aspect of managing pain, occupational therapy practitioners should consider the client’s readiness for change; occupational therapy interventions typically ask the client to alter or develop new habits and routines related to managing their pain (HHS, 2019). Most important, the practitioner should work to identify the client’s goals for occupational performance and pain management. It is important for clients to understand that eliminating their pain may not be realistic and that becoming an active participant in their own pain management may be the most beneficial strategy for achieving their personal goals, which may include increasing participation in occupation (IOM, 2011).
Occupational therapy for the management of pain is considered a nonpharmacological treatment and is recommended regardless of whether the client is receiving an opioid prescription (Dowell et al., 2016; HHS, 2019; IOM, 2011). Occupational therapy interventions provide distinct value in the treatment of pain by placing the focus of intervention on improving participation in valued occupations and by using occupation itself as a medium for therapy (Hill, 2016; Lagueux et al., 2018). The occupational therapy practitioner uses a top-down approach to determine appropriate interventions that address the occupational deficits caused by pain, taking into account the biological, psychological, and social factors that influence pain and the interactions among the person, environment, and occupational engagement, which can be complex (Lagueux et al., 2018). The occupational therapy practitioner also considers the identified needs of the individual, group, or population, including barriers to occupational performance (Hesselstrand et al., 2015; Hill & Macartney, 2019). Interventions should focus on occupations, with activities used as needed but only to support occupational participation. In addition, occupational therapy practitioners may consider the use of complementary health approaches and integrative health to support occupational participation, following established guidance related to scope of practice (AOTA, 2017a). The following sections provide examples of types of interventions that would be appropriate for treating pain, using OTPF–4 Table 12 as a guide (AOTA, 2020b, p. 59).
Occupations
The occupational therapy practitioner uses occupation and activities, the components of occupation, as the primary intervention to support achievement of client and therapeutic goals (AOTA, 2020b). The therapeutic use of occupation involves the occupational therapy practitioner ensuring that the activity addresses the mental, physical, and spiritual needs of the client (AOTA, 2020b). For a client with pain, the practitioner would consider the client’s biopsychosocial factors when determining appropriate occupations and activities for treatment. As the client works to improve their ability to self-manage their pain, the occupational therapy practitioner may facilitate the client’s incorporating self-management strategies, also considered an occupation, into daily routine. Occupation, including ADLs and IADLs, may be used in training the client in concepts such as pacing; energy conservation; health management routines, such as exercise and sleep; body mechanics; and posture. An example would be the occupational therapy practitioner using the occupation of dancing when training the client in appropriate frequency, duration, and intensity of physical activity for chronic pain, because this has been shown to significantly reduce pain (Ambrose & Golightly, 2015). The types of interventions that are discussed in this document often use occupation or components of occupation as a therapeutic medium.
Physical Agent Modalities and Mechanical Modalities
Occupational therapy practitioners may use physical agent and mechanical modalities (PAMs) and provide training to the client in the safe self-application of PAMs as a coping strategy to address client factors that increase pain or stiffness and to promote occupational engagement (AOTA, 2018b; Dehghan & Farahbod, 2014; Honda et al., 2018). These interventions should be used only in preparation for occupation and should focus on self-management (AOTA, 2018b, 2020b).
Assistive Technology and Environmental and Activity Modifications
Occupational therapy practitioners assist with selecting assistive technology and training the client in its use and with adapting or modifying the environment or activity to support participation in occupation despite pain. For example, in the intervention of pacing, the practitioner assists the client in preplanning to ensure a balance between rest and activity (Guy et al., 2019; Jamieson-Lega et al., 2013). Occupational therapy practitioners also instruct clients in the use of body mechanics, ergonomics, and joint protection techniques during performance of daily tasks to promote postures that minimize or manage pain during occupation (Hill & Macartney, 2019; Lieber et al., 2000; Siegel et al., 2017). To address socialization, clients may benefit from trialing and problem-solving modifications to social activities (Benjamin et al., 2012; Wolf & Davis, 2014). Assistive technology such as virtual reality simulation may be used during occupational therapy treatment to promote relaxation or increase movement (Alemanno et al., 2019; Spiegel et al., 2019; Won et al., 2017).
Self-Regulation
Self-regulation interventions include sensory reeducation, desensitization training, and graded exposure. Pain can be a disease in itself when certain client factors are present (e.g., sensitization of the nervous system), and self-regulation treatments based on sensory processing principles may benefit the client. Intervention may include activities to address client factors, such as mindfulness (Dorado et al., 2018; Goodman et al., 2019; Zeidan et al., 2019) and biofeedback (Sielski et al., 2017). Graded exposure may also be beneficial; in this intervention, the practitioner provides guidance as the client participates in occupations the client usually avoids or fears. The practitioner educates the client to recognize catastrophizing thoughts during performance and guides a gradual increase in activity demands to manage pain and achieve maximum participation (Dekker et al., 2020; López-de-Uralde-Villanueva et al., 2016; Malfliet et al., 2019). In addition, the practitioner can include exposure interventions to specifically target neuroplasticity, such as graded motor imagery (Anderson & Meyster, 2018; Limakatso et al., 2016) and mirror therapy (Goswami et al., 2016; Wittkopf & Johnson, 2017).
Practitioners may provide pain neuroscience education to help clients understand the underlying client factors influencing their pain and the ways self-management activities can help them manage the pain (Louw et al., 2016; Van Oosterwijck et al., 2013). Occupational therapy interventions that address attention, memory, and executive function may be indicated because studies have shown that adults with chronic pain may be more likely to demonstrate deficits in attention, spatial and working memory, and executive function that may be obstacles to completing everyday tasks. It is not yet understood whether the relationship between chronic pain and cognition is causal or simply an association. The occupational therapy practitioner may consider the potential for cognitive impairment and provide training, resources, and environmental modifications on the basis of the client’s cognitive abilities (Ferreira et al., 2016; Moriarty et al., 2011; Scemes et al., 2017).
Self-Management Training
On the basis of evidence strongly supporting the benefit of self-management in addressing pain, many occupational therapy interventions promote the client’s ability to incorporate self-management into daily habits and routines. Such interventions include coping skills training and training with practice to incorporate self-regulation strategies for pain. Examples of self-management training include the following: Training to facilitate the development of skills to meet goals such as pacing and body mechanics. Goal-directed treatment is part of current recommendations for treating pain (Dowell et al., 2016; HHS, 2019). Training for pain flare management, also referred to as relapse prevention, including skills for identifying symptoms of increasing pain and implementing strategies to address the pain flare (Simon & Collins, 2017). Training to address the psychosocial components of pain to promote adaptive belief patterns regarding participation in occupations. Examples of this training include both cognitive–behavioral therapy and acceptance and commitment therapy, which are widely recognized as treatments for pain (Boschen et al., 2016; Hann & McCracken, 2014; Hughes et al., 2017; Knoerl et al., 2016; Law, Fisher, et al., 2019). Training in the use of expressive activities such as art or writing to increase client self-efficacy, a skill required for self-management (Lynch et al., 2013; Ziemer et al., 2015).
Self-management training should always work toward skill acquisition for direct application to the client’s daily life (AOTA, 2020b).
Medication Management
Assessment of medication management strategies is important when treating a client with pain. Cognitive deficits, which are often correlated with pain, may diminish the client’s performance of this task. Medication nonadherence can lead to adverse health outcomes, including death (IOM, 2010). Current recommendations and guidelines regarding opioid prescribing may add greater complexity to medication management tasks because of expectations such as secure medication storage, regular urine drug testing, random or routine pill counts, more frequent visits to the provider for prescriptions, and accurate reporting of all prescriptions to the prescribing provider. Occupational therapy practitioners can be guided in addressing medication management, including considerations such as the impact of medication side effects (e.g., fatigue) on daily occupations, by the document “Occupational Therapy’s Role in Medication Management” (AOTA, 2017b).
Advocacy
HHS (2019) has identified stigma as a major concern for people with pain because stigma can act as a barrier to care and can have far-reaching effects on both people with pain and those who care for them. Occupational therapy practitioners advocate to reduce stigma for people with pain, especially for those being treated with a prescription opioid (HHS, 2019). Current recommendations to reduce stigma include educating interdisciplinary team members, the public, and appropriate groups about disease processes and interventions for acute and chronic pain (Breeden & Rowe, 2017; Rowe & Breeden, 2018).
Self-Advocacy
One determinant of effective pain self-management is self-efficacy, or clients’ confidence in their ability to cope and carry out the tasks required to adequately function while experiencing pain. Occupational therapy practitioners work to improve client self-efficacy through training to increase assertiveness in self-advocacy. For example, clients need to self-advocate in preplanning social activities and altering components to ensure they can best manage their pain (Benjamin et al., 2012). Improving self-efficacy and self-advocacy skills also empowers clients to more confidently direct the care they receive from health professionals.
Group Interventions
Many pain management interventions can be delivered in a group format. Education groups can be used before surgery to provide training in expectations of pain after surgery and appropriate nonpharmacological treatments (Kennedy et al., 2017). Chronic pain support groups may facilitate clients’ desire for socialization and reinforce self-management concepts (Finlay & Elander, 2016). HHS (2019) noted that support groups can increase access to care for people with pain. Occupational therapy practitioners understand group dynamics and are prepared to facilitate these groups.
Virtual Interventions
When barriers to access to care are a concern for clients with pain, occupational therapy practitioners can deliver evaluation and treatment of pain through virtual interventions to help increase access to care (AOTA, 2018c, 2020b; HHS, 2019). Telehealth provides a way to support clients in the self-management of their pain in their own context (HHS, 2019). Virtual interventions can address care at the person, group, and population levels.
Ethical Considerations
Occupational therapy practitioners have a professional and ethical responsibility to provide services only within each practitioner’s level of competence and scope of practice. The AOTA 2020 Occupational Therapy Code of Ethics (AOTA, 2020a) establishes principles that guide safe and competent occupational therapy practice and that must be applied when addressing pain. Practitioners should ensure that they obtain an understanding of pain physiology, pain processing, pain-related disability, and pain-related interventions. Additional educational and certification opportunities for health care professionals in pain management are available through various organizations. Practitioners should refer to relevant principles in the Code of Ethics and comply with state and federal regulatory requirements.
Conclusion
Occupational therapy practitioners are prepared to address the needs of people with pain within the biopsychosocial model through their training in biological, psychological, and social sciences and their ability to focus on the mind–body–spirit connection. Because of the prevalence of pain, occupational therapy practitioners are likely to encounter clients with pain in most treatment settings. Occupational therapy practitioners are encouraged to follow HHS’s (2019) recommendations for health care professionals to pursue continuing education and training in pain management to improve outcomes for those with pain. Occupational therapy practitioners must also work to promote their distinct role in treating pain within a biopsychosocial model to all stakeholders to ensure that occupational therapy’s value of improving occupational engagement for those with pain is recognized.
Authors
Kimberly Lowe Breeden, MS, OTR/L
Niccole Rowe, BA, COTA/L
Contributing Authors
Talitha Black, MA, OTR/L, SWC, PAM, HTC
Linda Crawford, OTR/L, CDWF
Meadow Deason, OTD, OTR/L, CEES
Megan O. Doyle, MS, OTR/L, FPS, Cert-APHPT
Michael A. Pizzi, PhD, OTR/L, FAOTA
For The Commission on Practice
Julie Dorsey, OTD, OTR/L, CEAS, FAOTA, Chairperson
Adopted by the AOTA Representative Assembly, May 2021
Copyright © 2021 by the American Occupational Therapy Association.
Citation. American Occupational Therapy Association. (2021). Position Statement—Role of occupational therapy in pain management. American Journal of Occupational Therapy, 75(Suppl. 3), 7513410010. https://doi.org/10.5014/ajot.2020.75S3001